• Medicina clinica · Sep 2021

    Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection.

    • Juan Caro-Codón, Juan R Rey, Antonio Buño, Angel M Iniesta, Sandra O Rosillo, Sergio Castrejon-Castrejon, Carlos Merino, Irene Marco, Luis A Martinez, Jose M Garcia-Veas, Lorena Martin-Polo, Laura Rodriguez-Sotelo, Marcel Martinez-Cossiani, Luis Gonzalez-Valle, Alicia Herrero, Esteban López-de-Sá, Jose L Merino, and CARD-COVID Investigators.
    • Cardiology Department, Hospital Universitario La Paz, Madrid, Spain. Electronic address: juancarocd@gmail.com.
    • Med Clin (Barc). 2021 Sep 24; 157 (6): 274280274-280.

    BackgroundMyocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.MethodsConsecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.ResultsA total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.ConclusionElevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

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